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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The key areas of scientific research in general internal medicine are (1) prevention; (2) the natural history of common illnesses; (3) improving the outcomes and efficiency of the health care system and (4) orphan diseases. Disease prevention is at the top of the list because of the enormous role preventable causes play in morbidity and mortality, above all tobacco. Research in this field is difficult because it touches such questions as individual behaviour and personal choice. Research in the natural history of common illnesses is critical to informed patient decision making. Recent studies show that procedures thought to be safe bear a high percentage of complications, when viewed from the generalist's point of view: high incidence of strokes after elective coronary bypass surgery; higher mortality rates among patients having had pulmonary catheterization; high incidence of incontinence and impotence after transurethral resection of the prostate. A third area for research in primary care is how to improve outcome and efficiency through improvements in the health care delivery system. This field touches the problem of unnecessary surgical interventions and inappropriate prescription of antibiotics. Orphan diseases in this context are conditions no speciality wants to study, such as dementia and low back pain. The most important obstacle for research in the field of general internal medicine is funding. It is much easier to be funded for research in high profile conditions, like heart disease, cancer and AIDS. A second barrier to research relates to the role of special interest groups in influencing not only funding but also policy. Important examples were the pressure on consensus conference decisions on the role of spinal fusion surgery for low back pain and on the question whether women between 40 and 50 should have annual mammography. For generalist research to be fruitful it is of outmost importance to have an adequate intellectual infrastructure, i.e. support by epidemiologists, biostatisticians, economists and research methodologists.
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PMID:Scientific evidence and research in primary care. 954 Jan 37

The potential for good health is largely dependent on the prevention and reduction of early onset of fatal disease and death. The male population, in particular, is at risk from early onset of fatal disease and death. Prevention strategies must be developed in order to reduce the risk factors leading to the currently most common causes of death (heart disease, cancer, accidents). Due to the increase in life expectancy, however, other illnesses generally affecting the elderly population (osteoporosis, dementia, cancer, heart attack, incontinence etc.) are gaining in significance. The above average reduction in life expectancy in men can be counteracted particularly through preventative measures and the active promotion of good health. In particular risk factors, such as, smoking, overweight, high blood pressure and metabolic disease, are responsible for the high mortality rate in men. New research areas must be defined for the male population, which particularLy focus on the ageing male. In the field of age related illness, gender specific investigations are definitely required. The main focus has to be on therapy and prevention of those diseases and their subsequent debilitating effects, that commonly effect the elderly. Particularly with men there is still a deficit of information with regards the role of hormones and their relationship with andropause and ageing.
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PMID:[Social medicine aspects of the aging man]. 1181 49

Vascular parkinsonism has not been well defined and the clinical correlation of vascular parkinsonism is still not clear. The aim of the study was to estimate prevalence of occurrence of vascular parkinsonism, analysis of risk factors leading to its development and to identify clinical features that suggest a vascular origin. 214 patients with Parkinson's disease were examined. Their ages ranged from 37 to 88 years (median 66.4 years). Evidence of vascular parkinsonism was assessed using a vascular rating scale previously described by Winikates and Jankovic. Statistical analysis was performed with Mann-Whitney U test, chi 2 Pearson test, chi 2 Yates test, Spearman rank correlation and Student's t test. Out of 214 patients 8 were proved to have developed Parkinson's disease due to vascular disease, what gave 3.74%. Out of risk factors for stroke 5 patients had hypertension, 3 had diabetes mellitus, 2 suffered from heart disease, 2 had infarctus myocardii, 1 had hyperlipidemia, 1 had atrial fibrillation. Additionally, those patients had neuroimaging (CT or MRI) evidence of vascular disease in one or more vascular territories. Patients with vascular parkinsonism were older, had shorter duration of disease, were more likely to present rigidity rather than tremor. Dementia and incontinence were more common in vascular group than in Parkinson's disease group. Patients with vascular parkinsonism were also significantly more likely to have corticospinal findings. Proving that Parkinson's disease had vascular etiology is extremely difficult. The test results are inconclusive.
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PMID:[Clinical correlation of vascular parkinsonism]. 1509 42

Overactive bladder (OAB) affects millions of people in the United States and is associated with poor health, impaired quality of life, social isolation, and depressive symptoms. Despite the high prevalence of this syndrome, studies show that it is not adequately addressed by the busy primary care physician, who may be preoccupied with management of other chronic diseases perceived as more serious such as heart disease, diabetes mellitus, and hypertension. Pharmacologic flexible-dosing studies with anticholinergic agents offer a relatively simple strategy for optimal management of OAB: physician-initiated, patient-managed dose adjustment. Recent flexible-dosing studies with extended-release oxybutynin, darifenacin, and solifenacin suggest that urge urinary and total incontinence episodes may be reduced significantly with a flexible-dosing strategy. Dose adjustment may improve the therapeutic outcome, facilitating a balance between efficacy and anticholinergic side effects such as dry mouth. Flexible-dosing studies indicate that dry mouth, the adverse effect most frequently seen with the use of anticholinergic agents, seldom leads to study withdrawal. Patient-initiated control of OAB symptoms may be achieved in 1 month by following established protocols.
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PMID:Pharmacologic management of overactive bladder: practical options for the primary care physician. 1648 65

In the United States, 4.9 million people aged 65 years and older have Alzheimer's disease (AD). Medicare costs for patients with heart disease, diabetes, congestive heart failure, or chronic obstructive pulmonary disease and dementia are higher than for those without dementia. Although one principle of care for persons with AD is "do not hospitalize," comorbidities may require inpatient care. This article presents a definition, the diagnostic criteria for AD, and information about differential diagnosis, risk factors, pathology, progression, evidence base for practice, assessment, pharmacologic management, guidelines for general inpatient care, discharge planning, and interventions related to communications, environment, spirituality, special tasks (eating, protecting tubes and dressings, bathing), stages of AD, and special problems (wandering, pain, incontinence, hallucinations, aggression).
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PMID:Inpatient care for persons with Alzheimer's disease. 1831 39

The population of older Americans is expected to represent 20 percent of the total U.S. population in the next 50 years, and older women will comprise the majority of that group. Thus, the health care needs of older women are and will be an increasing concern. A subcommittee of the Public Health Service Task Force on Women's Health, which studied the health issues related to older women, observed that many factors relate to the health care of this group. Several factors, such as the homogeneity of the population over 65 years, the distinction between normal aging and disease, and the impact of socioeconomic concerns on physical and mental health, are important for developing preventive and treatment strategies.Older women die of the same disorders that affect men-heart disease, cancer, cardiovascular disease, and accidental injuries-but are more likely to be afflicted with one or more chronic conditions that can cause limitations in their lifestyles (for example, diabetes, hypertension, arthritis).The subcommittee also highlighted disorders with special implications for older women such as incontinence, osteoporosis, prescription drug misuse, and depression, and recommended that health messages for older women be targeted at both young and old cohorts to encourage health promotion and good health practices at all ages.
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PMID:Health concerns of older women. 1931 90

Patients who have had a stroke are susceptible to many complications. These individuals commonly have comorbidities such as hypertension, diabetes, heart disease, or other ailments that increase the risks of systemic medical complications during stroke recovery. However, several complications can arise as a direct consequence of the brain injury itself, from the ensuing disabilities or immobility, or from stroke-related treatments. These events have a substantial effect on the final outcome of patients with stroke and often impede neurological recovery. Cardiac complications, pneumonias, venous thromboembolism, fever, pain, dysphagia, incontinence, and depression are particularly common after a stroke and usually require specific interventions for their prevention and treatment. However, there are few data to guide the management of these complications. Systematic investigations are therefore needed to further study the effects of medical complications on stroke recovery and to improve interventions for the prevention and treatment of these events.
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PMID:Medical complications after stroke. 2008 36

Diabetes in the elderly is a growing public health burden. Persons with diabetes are living longer and are vulnerable to the traditional microvascular and macrovascular complications of diabetes but also at increased risk for geriatric syndromes. Peripheral vascular disease, heart disease, and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status. Older adults with diabetes are also more likely to experience geriatric syndromes such as falls, dementia, depression, and incontinence. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of adverse complications from diabetes.
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PMID:Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. 2401 32